CHI St. Luke’s Health Memorial Cath Lab Procedure Walkthrough

The CHI St. Luke’s Health-Memorial Cath Lab is a bustling hub of activity. In 2017, nearly 3,000 cardiovascular procedures were performed in one of the four Memorial cath labs – on average 55 cases per week.

The 16 members of the Cath Lab team are sorted into 4-man teams by their discipline and expertise to tackle the variety of diagnostic and interventional procedures performed daily. Each team consists of two Registered Nurses and two Radiology Technologists – all highly and specially trained. Elective procedures are scheduled each day, but there are also moments when the Cath Lab team is racing against the clock to save a heart attack victim. In every situation, the skillsets of the interventional cardiologists and those working alongside them are invaluable. The team must be keenly aware of the situation at hand. Their schedules and the nature of their occupation are demanding. They are constantly on their feet. They must be quick thinkers, problem solvers and have an immense knowledge of the anatomy of the cardiovascular system. And they must be ready to save lives at all times.

Each day provides a new challenge.

At 7:00 a.m. every morning, the members of the Cath Lab staff arrive at the CHI St. Luke’s Health Heart and Stroke Center to determine the day’s schedule, put on their black scrubs and begin preparing patients for the procedures scheduled for that day.

On Monday, January 8, Rita Fowler, 52, arrives at CHI St. Luke’s Health-Memorial with her mother. She is greeted and escorted to the 2nd floor of the Heart and Stroke Center. She fills out necessary paperwork, has her vital signs read and receives an IV. She is expecting to stay overnight in the hospital. Before today, Rita saw Yugandhar Manda, M.D., a board certified Interventional Cardiologist with the Heart Institute of East Texas, at his clinic in Jasper. Her echocardiogram and nuclear stress test came back abnormal, and the decision was made to perform a diagnostic heart catheterization to definitively determine whether Rita had any blockages in the arteries to the heart muscle that would explain her symptoms and abnormal test results.

12:30 p.m. Dr. Manda arrives and begins the sterilization process of scrubbing in and putting on his mask, scrub hat, a specially designed lead apron to protect himself from radiation in the Cath Lab, and a blue sterile gown.

12:35 p.m. Two nurses take Rita to Cath Lab Room 1 where the minimally invasive procedure will be performed by inserting a small catheter through the artery in her wrist. She is transferred from her hospital bed onto the cath table. She is modestly draped with sheets, the medical instruments are made ready for the physician’s use, and emergency medications are available, if needed.

12:57 p.m. The procedure begins. Rita is consciously sedated so she is relaxed and comfortable on the table. After getting numbing medicine on her wrist, she doesn’t feel the small catheter being inserted. Large screens display images of Rita’s heart which are captured by one of the radiology technologists. These images help Dr. Manda guide the catheter to her heart, and contrast is injected to determine where the blockages may be.

1:13 p.m. After discovering two blockages within Rita’s heart, Dr. Manda confers with his colleague Sireesha Garikipati, M.D., a fellow board certified Interventional and Nuclear Cardiologist with the Heart Institute of East Texas, on the best course of action. The cardiologists in Lufkin often collaborate, especially in cases with complex anatomy or high risk interventions.

“Everyone is so supportive and that’s the best part of this,” Dr. Garikipati said. “Different doctors have different experiences. Some have done this for 20 years and some have been trained to use the latest technologies. It’s always great to have their perspective. The patient comes first, so whatever is best for them is what we do.”

Rita’s right coronary artery has a chronic obstruction which can be extremely challenging and difficult to open, according to Dr. Manda. Her left anterior descending artery is about 60 percent blocked. They must decide if Dr. Manda should go ahead and resolve the issue.

Dr. Manda speaks with Rita about what he has found on the initial images. He explains the two available options. One option is to attempt to open the blockage through the approach in the wrist, which may prove to be challenging, or to reschedule the procedure to be performed through an approach in the groin. After their discussion, Rita would like Dr. Manda to try to open the blockage through her wrist.

1:18 p.m. The procedure proceeds. Always prepared for the unexpected, the team calls Cardiothoracic and Vascular Surgeon David Ladden, M.D. to “stand by” in case of an emergency.

1: 25 p.m. Rita is given additional blood thinners, and Dr. Manda attempts to open the blockage in her right coronary artery.

1:36 p.m. Dr. Garikipati scrubs in to assist.

1:50 p.m. There is excessive mobility of the heart and the arteries because of Rita’s deep breathing. The attempts to safely pass the wires and balloons into her blockage are unsuccessful. It is decided that more aggressive maneuvers to advance the equipment through the wrist would put Rita at an unnecessary risk. Considering her blood is very thin at the moment, Dr. Manda does not recommend inserting additional needles. Because Rita is not in any emergent danger, they decided to schedule a second procedure at a later date with a cardiovascular surgeon present.

“It was worth a try, but comfort and safety of the procedure with the best possible outcomes for our patients are our at most important goals,” Dr. Manda said. “We will try again to clear her blockages, and I’m certain that once that happens, she will begin to feel much better.”

Rita is then taken back to recovery before being moved into a patient room for the night.

However, the day is far from over for the Cath Lab team. There are still charts to complete. Any patient staying overnight needs a hospital bed, so they must wait until the patient is transported elsewhere. More cases are scheduled for the day with different physicians and an emergency could happen at any moment. The hours are long and grueling, but ultimately, very rewarding.

“This is what we have chosen to do,” Dr. Garikipati said. “This gives me satisfaction. I love doing this. If I get called in during an emergency I get so excited because I think, ‘I’m going to get to go and save a patient’s life.’ That’s the priority for me.”